This is an exciting time to study psychopathology. Research on the entire range of psychological disorders has blossomed during the last decade, yielding new insights about psychological disorders and their treatments. However, the research results are outpacing the popular media’s ability to explain them.
We’ve noticed that when study results are explained in a television news report or a mainstream magazine article, “causes” of mental illness are often reduced to a single factor, such as genes, brain chemistry, irrational thoughts, or social rejection. But that is not an accurate picture. Research increasingly reveals that psychopathology arises from a confluence of three types of factors: neurological (brain and body, including genes), psychological (thoughts, feelings, and behaviors), and social (relationships and communities). Moreover, these three sorts of factors do not exist in isolation, but rather mutually influence each other.
We are a clinical psychologist (Rosenberg) and a cognitive neuroscientist (Kosslyn) who have been writing collaboratively for many years. Our observations about the state of the field of psychopathology—and the problems with how it is sometimes portrayed—led us to envision an abnormal psychology textbook that is guided by a central idea, which we call the neuropsychosocial approach.
This approach allows us to conceptualize the ways in which neurological, psychological, and social factors interact to give rise to mental disorders. These interactions take the form of feedback loops in which every type of factor affects every other type. Take depression, for instance, which we discuss in Chapter 6: Someone who attributes the cause of a negative event to himself or herself (such attributions are a psychological factor) is more likely to become depressed.
But this tendency to attribute the cause of negative events to oneself is influenced by social experiences, such as being criticized or abused. In turn, such social factors can alter brain functioning (particularly if one has certain genes), and abnormalities in brain functioning affect social interactions, and so on—round and round.
The neuropsychosocial approach grew out of the venerable biopsychosocial approach; instead of focusing broadly on biology, however, we take advantage of the bountiful harvest of findings about the brain that have filled the scientific journals over the past two decades. Specifically, the name change signals a focus on the brain itself; we derive much insight from the findings of neuroimaging studies, which reveal how brain systems function normally and how they have gone awry with mental disorders, and we also learn an enormous amount from findings regarding neurotransmitters and genetics.
Although mental disorders cannot be fully understood without reference to the brain, neurological factors alone cannot explain these disorders; rather, mental disorders develop through the complex interaction of neurological factors with psychological and social factors. We argue strongly that psychopathology cannot be reduced to “brain disease,” akin to a problem someone might have with his or her liver or lungs. Instead, we show that the effects of neurological factors can only be understood in the context of the other two types of factors addressed within the neuropsychosocial approach.
Thus, we not only present cutting-edge neuroscience research results but also put them in their proper context. (In fact, an understanding of a psychological disorder cannot be reduced to any single type of factor, whether genetics, irrational thoughts, or family interaction patterns.)
Our emphasis on feedback loops among neurological, psychological, and social factors led us to reconceptualize and incorporate the classic diathesis-stress model. In the classic view, the diathesis was almost always treated as a biological state, and the stress was viewed as a result of environmental events. In contrast, after describing the conventional diathesis-stress model in Chapter 1, we explain how the neuropsychosocial approach provides a new way to think about the relationship between diathesis and stress. Specifically, we show how one can view any of the three sorts of factors as a potential source of either a diathesis (a precondition that makes a person vulnerable) or a stress (a triggering event).
For example, living in a dangerous neighborhood, which is a social factor, creates a diathesis for which psychological events can serve as the stress, triggering an episode of depression. Alternatively, being born with a very sensitive amygdala may act as a diathesis for which social events—such as observing someone else being mugged—can serve as a stressor that triggers an anxiety disorder.
Thus, the neuropsychosocial approach is not simply a change in terminology (“bio” to “neuro”), but rather a change in basic orientation: We do not view any one sort of factor as “privileged” over the others, but regard the interactions among the factors—the feedback loops—as paramount. In our view, this approach incorporates what was best about the biopsychosocial approach and the diathesis-stress model. The resulting new approach led naturally to a set of unique features, as we outline next.
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Abnormal Psychology by Robin S.Rosenberg & Stephen M. Kosslyn